.\Isr\x. 



'icprinlcd from The Journal of the American Medical Association^ 
September 28, 1907, Vol. xiix, pp. 1088-1098. 

Copyright, 1£07. 
American Medical Association. JO) Dcarhorn Arc, Chicago. 



THE mhK SUPPLY OF AVASHI^^GTOX, D. C* 



G. LLOYU MAGRUDER, M.D. 

AVASniXGTOX, D. C. 



During the summer of 190G, notwithstanding the 
completion of, and the satisfactory results obtained 
from, the Washington filtration works, it was found, 
contrary to the general expectation, that there was no 
diminution in the prevalence of typhoid fever. Owing 
to the limited force of inspectors under the health offi- 
cers and the entire absence of a bacteriologic laboratory 
under his control, no extended investigation into the 
causation of this condition could be conducted. Conse- 
quently, in June, 1906, the District Commissioners re- 
quested the aid of the Bureau of Public Health and Ma- 
rine-Hospital Service toward solving this problem. The 
work of the bureau covered the conditions that existed 
withm the limits of the District. Very early in the 
course of the investigations attention was ""f orcibly drawn 
to the milk supply. A summary of work done was sub- 
mitted to the District Commissioners in March last. 
Ten per cent, of the cases of typhoid fever examined 
were directly traced to milk infection. The study of 
the methods of receiving, handling, caring for and' dis- 
tributing milk showed a most deplorable state of affairs. 
This will be shown in great detail in the full report 
which is to be issued shortly. 

On June 6, 1894, I, as chairman of a committee, pre- 
sented a report on typhoid fever in the District of Co- 
lumbia to the medical society of the district. This re- 
port was afterward presented to the district committees 
of both houses of Congress and was printed as a public 
document. While preparing this report the many in- 
sanitary conditions connected with the milk supply were 

*F:pad in the Section on Hygiene and Sanitary Science of the 
American Medical Association., at the Fifty-eighth Annual Session, 
lu-'id at Atlannc Cily. .Tune,li;07. 






noticed. "Contaminated milk" was mentioned as a 
prominent cause of the disease. Among the recommen- 
dations of this committee which were unanimously 
adopted by the society were : ^'The construction of works 
for the filtration of the Potomac water, the only proper 
method of purification; the abandonment of all wells 
as rapidly as possible within the city limits. Careful 
purification and inspection of all dairies in the District 
from wdiich the milk supply is drawn; and the enact- 
ment of a law whereby no milk shall be sold in the Dis- 
trict without a permit from the health office. The in- 
spection should cover an examination at the dairies of 
all possible sources of infection, including the water 
supply." 

Early in September, 1906, I had a conference with 
the Hon. James Wilson, the Secretary of Agriculture, 
and discussed with him the insanitary conditions that 
had been observed on dairy farms, as well as the numer- 
ous reports of contaminated waters, as shown by re- 
peated chemical analyses. The advisability was urged 
of carrying out the recommendation as to dairy farms 
made by the committee of the medical society in 1894. 
Eepeated examinations of the milk supply in a number of 
states and the general conditions surrounding the same 
have been made by the Department of Agriculture. The 
Secretary immediately took great interest in the sub- 
ject. Fully appreciating that a study of the sources of 
supply would be of great value, he directed that careful 
and thorough inspection should be made of every source 
of supply of milk to the city from the District of Co- 
lumbia, Maryland and Virginia. 

The results as obtained were from time to time re- 
ported. Most astounding conditions were found to 
exist. Especially interesting were the bacteriologic in- 
vestigations of the water supply of sixty dairy farms, 
which were made by the Department of Agriculture in 
November and December, taken without selection in 
Maryland, Virginia and the District of Columbia. These 
showed that but 25 per cent, were under the danger line, 
considering that 500 bacteria to the cubic centimeter, 
when uncontaminated with sewage bacteria, is the limit 
of perfect safety; twenty-seven showed the presence 
of bacillus coli — 45 per cent. A number of wells or 
springs examined contained over 20,000 bacteria to the 
cubic centimeter; one contained 27,200. 

Gift 
Author 

(Person) 



3 

Two cases of fever were in actual existence on two 
farms at the time of the examination of the water sup- 
})ly, one in Mar3'land and one in A^irginia. 

This knowledge, in the light of the recent reports of 
Dr. Schroeder showing the presence of the tubercle 
bacillus in the feces of cows and those of Dr. Soper as 
to the presence of the typhoid bacillus in the feces of a 
patient, demands that greater attention should be paid 
to water supplies showdng the colon bacillus. The bac- 
teriologic investigation of the w^ater supply of farms has 
been continued and additional reports are now^ available. 
These show increased contamination, probably the re- 
sult of spring rains and the warmer weather. 

These studies have been found so interesting that the 
Secretary of Agriculture has ordered a repetition of the 
inspection of the 1,000 farms supplying Washingion. 
This inspection will include a bacteriologic examination 
of the water supply of each farm. The Bureau of Pub- 
lic Health and Marine-Hospital Service examined bac- 
teriologic? lly 172 samples of milk during August and 
September, with an average of 22,134,259 bacteria. 
The Department of Agriculture supplemented this work 
by examining 372 samples from October 27 to Decem- 
ber 3, 190G, comparatively cool weather,- and found an 
average of 977,315. Eecently the same department has 
examined 130 samples of ice cream. Five of these sam- 
ples contained less than 500,000 bacteria to the cubic 
centimeter, the remainder ranged from over 1,000,000 to 
3G4,000,000 per cubic centimeter. These figures draw at- 
tention to a most dangerous factor as a probable cause 
of disease. 

The information obtained from these investigations 
conducted by these two great departments of the govern- 
ment, 'the Department of Agriculture and the Bureau 
of Public Health and Marine-Hospital Service, so im- 
pressed the District Commissioners that they, on March 
30, 1907, addressed a letter to a number of prominent 
government officials and leading citizens inviting them 
"to confer with respect to the milk supply in the District 
of Columbia, and to advise them what further steps 
should be taken to improve it, especially with reference 
to the question of employing either certification of milk 
of standard excellence or the pasteurization of the Dis- 
trict milk supph^, or both, and what amendments should 
be made to the commissioners' bill for the better regu- 



latioii of the milk business introduced in tlie last session 
of Congress." 

On April 10 the men invited to this conference met 
and organized the Milk Commission with the following 
officers : 

Chairman. — Gen. Geo, M. Sternberg, Surgeon General, U. S. 
Army, retired. 

Vice Chairmen. — Dr. Harvey W. Wiley, Department of Ag- 
riculture, and Dr. Geo. M. Kober, Professor of Hj'giene, School 
of Medicine, Georgetown University. 

Secretary. — Dr. W. C. Woodward, District Health Officer. 

Several subcommittees were appointed. 

Subcommittee on Infant Feeding: Chairman, Dr. Harvey 
W. Wiley, Chief of Bureau of Chemistry, U. S. Department 
of Agriculture; Gen. Geo. M. Sternberg, Dr. Stitt, U. S. Navy; 
Dr. J. W. Kerr, Asst. Surgeon General, Bureau of Public 
Health and Marine-Hospital Service; Drs. D. P. Hickling, 
Wm. M. Sprigg, and W. C. Woodward. 

Subcommittee on the Sanitary Condition of tlie ^lilk Sup- 
ply: Chairman: Dr. Geo. M. Kober, Professor of Hygiene, 
School of Medicine, Georgetown University. His associates 
were Drs. A. D. Melvin, Chief of Bureau of Animal Industry, 
U. S. Dept. of Agriculture; M. J. Pvosenau, Director of Hy- 
gienic Laboratory, U. S. P. and M.-H. S. ; John R. ]Mohler. 
Chief Pathologist, Bureau of Animal Industry, Department of 
Agriculture; Chas. T. Mason, Asst. Surgeon General, U. S. 
Army; G. Lloyd Magruder, Emeritus Professor of Materia 
Medica and Therapeutics, School of Hygiene, Georgetown Uni- 
versity, together with Messrs. E. H. Webster, Chief of Dairy 
Division, Bureau of Animal Industry, Dept. of Agricultvu-e, 
Col. Robert G. Smith, milk producer, and E. Berliner. 

The matter assigned to these committees was divided 
into several subheads and was so carefully and exhaus- 
tively considered by men well versed on the subject that 
copious excerpts from the reports which were submitted 
to the full commission on April 17 and May 1 and unan- 
imously adopted, are presented in abstract with the feel- 
ing that much of value will be given : 

Extracts from the recommendations unanimously adopted 
by the committee to consider milk in relation to the food of 
infants : 

1. The milk which is supplied to infants under the age of 
3 years in the District of Columbia should be certified by the 
health officer, and should contain not more than 10,000 bac- 
teria per cubic centimeter, should be not more than tAvelve 
hours old, and should be delivered in artificially cooled pack- 

OD'CS. 

•2. Th? health officer of the district should be authorized to 



advertise for dairies wliich will be willing to so modify their 
barns, stables, etc., if necessary, as to secure a license from 
him for the production of certified milk under the most modern 
improved sanitary conditions. 

3. Each cow furnishing the milk in the dairy should be tested, 
under the supervision of the health officer, for tuberculosis or 
other contagious or infectious diseases, and that any animal 
so suffering be excluded from the herd. 

4. A daily sample, or samples, drawn from the supply of 
each certified milk furnished to the city should be secured for 
the purpose of making the bacterial count and determining 
the chemical composition, etc. 

5. Parents and guardians should be urged to use onh' certi- 
iled milk, at least for infants' food in the District of Columbia 
for all infants under tho age of 3 years. 

6. If private dairies can not be induced to furnish certified 
milk, the commissioners of the District of Columbia, as a 
health measure afli'ecting in the highest degree tne welfare of 
the District of Columbia, should be asked, if it can legally be 
done, to establish a municipal dairy for the purpose of furnish- 
ing certified milk for the use of infants under 3 years of age 
in the District of Columbia. 

7. For the purpose of securing modified milk for infants in 
ill health, according to the prescription of physicians the Milk 
Commission of the District Medical Society should be re- 
quested to secure the establishment of a laboratory under its 
supervision in which only certified milk shall be used, and in 
which, by the use of a separator, or otherwise, milk of a defi- 
nite chemical composition may be prepared from certified 
milk, in harmony Avith tlie physicians' prescriptions relating 
thereto. 

10. The term "certified milk'' as used herein is to be applied 
to milk secured at dairies subject to a periodic inspection, and 
the products of which are subjected to constant analysis. The 
cows providing the milk are to be properly fed, free of tuber- 
culosis or other contagious diseases, and housed in clean 
stables, properly ventilated, and they are to l)e supplied with 
wholesome water and food, and kept clean. The milk is to be 
drawn under precautions to avoid infection, is to be immedi- 
ately strained and cooled, and packed in sterilized bottles 
which are to be kept at a temperature of about 40 degrees F. 
until delivered to the consumer. 

VARIOUS DISEASES AND CONDITIONS OF CATTLE 

THAT MAY AFFECT THE QUALITY OF THE 

MILK SUPPLY. 

BY JOHN R. MOIILEK. 

The importance of obtaining a hygienic and wholesome milk 
supply for the residents of this city is recognized by all intelli- 
gent people and should require no argument. Public health 



demands the purity of all milk and milk products. Next to 
bread, milk is more extensively used as an article of diet than 
any other foodstuff. It forms a portion of the food of almost 
every person practically every day of the year. Moreover, un- 
like many other articles of diet, milk is consumed in most 
cases in an uncooked state, making it a very dangerous food 
should it perchance contain any deleterious organisms. The 
reasons for securing a supply of pure and wholesome milk are 
so numerous and so important that the consumer should be- 
come acquainted with some of the more essential of them in 
order that he ma\- render assistance in bringing about a satis- 
factory improvement. Not only is milk a very suitable me- 
dium for almost every description of germ life which may gain 
access to it in its journey from the coav to the consumer, but 
it may also become coiitaminated while still in the udder 
through infectious or poisonous material present in the cow 
herself. Consideration in this report will be given only to the 
latter aspect of the question of a wholesome milk supply. In 
tnis connection it will be necessary to keep in mind the re- 
quirements of an awakened public for a clean and w^iolesome 
milk as well as the effect of any unreasonaule or irrational 
demand on the producer which may cause iiim heavy losses, or 
even to discontinue his business. 

It will also be apparent from the report of the Committee 
on Sanitation that in order to produce milk in compliance 
with the requirements hereinafter to be described, certain pre- 
cautions must be taken which will necessarily entail additional 
expense on the producer of this higher grade of milk. The 
customer must therefore expect to pay his portion of any legit- 
imate advance in the cost of production, and such increase in 
the price of milk due to its improved qualitj^ should be con- 
sidered as money well expended. Furthermore, we can not 
have good milk of safe quality without a realization on the 
part of the farmer, transportation agent, dairyman and house- 
wife of the danger in utilizing old, warm or dirty milk. f]du- 
cation is an important factor, therefore, in the improvement 
of the milk supply which can not be accomplished through 
laws and regulations alone. In view of these facts it is recom- 
mended that the subject be taught in the schools, that popular 
articles be frequently prepared for the press, that lectures 
and demonstrations be given in towns and townships, that 
pamphlets in plain language be prepared by the Health Officers 
for general distribution, and especially that rules and sugges- 
tions, with reasons therefor, be placed in the homes of dairy- 
men and dairy attendants. 

MILK FROM UNHEALTHY COWS AS A FACTOR IX THE SPREAD 
OF DISEASE. 

TvJberculo-^is. — P'-obably th.e most important disease of cows 
from the standpoint of public health is tuberculosis, and it is 



also the most prevalent. Xotwithstanding the announcement 
of Koch that, in his opinion, tuberculosis in man and cattle 
is a different disease, it is now the generally accepted opinion 
among scientists that people, especially children, may become 
infected with tuberculosis from cattle. It is not known to 
what extent such infection occurs, nor is it possible to obtain 
any definite percentage by the method formerly adopted of 
looking for the primary lesions in the intestinal canal, al- 
though much statistical evidence is recorded, showing that 
even by these figures primary intestinal tuberculosis of chil- 
dren has been observed in as high as 45.5 per cent, of the 
tuberculous cases examined. (Heller.) 

Evidence which must be considered conclusive has been ob- 
tained by the Bureau of Animal Industry as well as by Rav- 
enel and a number of French investigators, showing that tuber- 
culous infection may take place through the intestinal tract 
without leaving any lesion in the abdominal cavity, the first 
alteration being found in the lungs or thoracic glands. There- 
fore the presence of pulmonary tuberculosis in infants with- 
out intestinal lesions is no indication that the disease was 
not transmitted by the food, and the statistics above referred 
to are thus shown to be below the true percentage of cases of 
tuberculosis of intestinal origin. These figures, however, do 
not give any satisfactory idea as to whether the bacilli enter- 
ing the intestines originated from human or bovine sources. 
Owing to this fact, it follows that the only way of determining 
the infection of people by bacilli of the bovine type will be to 
study the lesions in the body of as many cases of human 
tuberculosis as is possible. 

The finding of the bovine type of tubercle bacillus in human 
lesions is the most direct and positive proof that tuberculosis 
of cattle is responsible for a certain amount of tuberculosis- 
in the human family. Numerous experiments with this object 
in view have already proven this fact. Thus the German com- 
mission on tuberculosis examined 10 different cultures ob- 
tained from tubercular lesions in children and found four 
which were more virulent than is usual for human tubercle 
bacilli, causing tuberculosis in the cattle inoculated with them, 
and making 25 per cent, of the cases tested, affected with a 
form of tuberculosis Avhich, by Koch's own method, must be 
classified as of bovine origin. In a similar series of tests con- 
ducted by the British royal commission on tuberculosis, 00 
cases of the disease in the human were tested, with the result 
that 14 cases were claimed by this commission to have been 
infected from bovine sources. Ravenel reports that "of 5 cases 
of tuberculosis in children, 2 received their infection from 
cattle. 

Theobald Smith has also reported on one culture of the bovine 
tubercle bacillus obtained from the mesenteric glands of a 
child out of 5 cases examined, and according to a recent 



paper by Goodale, Smith has recently been at work on 7 otlier 
cultures from diiferent children, 4 of which conformed lo his 
idea of tubercle bacilli emanating from cattle. Of 4 cases of 
generalized tuberculosis in children examined in the Biochemic 
Division of the Bureau of Animal Industry, 2 were found to 
be afl'ected with very virulent organism's, which warranted the 
conclusion that such children had been infected from bovine 
source. The Pathological Division of the same bureau has 
likewise, out of the 9 cases of infantile tuberculosis examined, 
obtained two cultures of tubercle bacilli that could not be 
differentiated from bovine culture. In Europe so manj'- similar 
instances of bovine tubercle bacilli having been recovered from 
human tissues are on record that it appears to your committee 
entirely proven that man is susceptible to tuberculosis caused 
by animal infections, and while the proportion of such cases 
can not be decided with even approximate accuracy, it is never- 
theless incumbent on us to recommend such measures as will 
guard against these sources of danger, when enforced.- 

The two principal sources of infection from cattle and the 
only ones necessary to be considered are the meat and milk 
of tuberculous animals. The fact that most of the cases of 
bovine tubr-rculosis above enumerated which occurred in the 
human were cases of infantile tuberculosis points with grave 
suspicion to the milk rather than the meat si^.pply. This nat- 
urally leads to the question of how and under what condition 
does the milk become infectious. That milk coming from a 
tuberculous udder is capable of transmitting the infectious 
principle is conceded by all who have given the subject any 
consideration. It has been equally established that in ad- 
vanced generalized tuberculosis the udder may secrete tubercle 
bacilli without showing any indication of being affected. 

Careful experiments performed by trained and eminently 
responsible investigators have also demonstrated beyond rea- 
sonable doubt that tubercle bacilli at certain times may be 
present in the milk of cows affected with tuberculosis to a 
degree that can be detected only by the tuberculin test, so 
that in a herd of cows in the various stages of tuberculosis it 
is to be expected that some of them will secrete tuberculous 
milk, which, when mixed Avith other cows' milk, makes the 
entire product dangerous. Even when the tubercle bacilli are 
not being excreted by the udder, it has been shown by Eber in 
Germany and Schroeder in this country, that the dust and 
manure of the stable where the diseased animals are kept are 
in many cases contaminated with tubercle bacilli. 

In a recent examination of tlie manure passed by twelve 
cows just purchased from dairy farms in this city and affected 
with tuberculosis to an extent only demonstrable by the tuber- 
culin test, tubercle bacilli were found in over 41 per cent, of 
the cases both by microscopic examination and animal inocula- 
tions. The danger from this method of infectin<x milk is im- 



i) 

pressed on us as tonsaniers when we realize that on an aver- 
age probably 25 per cent, of all the cows which supply milk 
to the district are tuberculous, and this is considered to be a 
conservative estimate, judging from the results of recent tuber- 
culin tests. Vital statistics show that 14 out of every 100 
people that die succumb to tuberculosis, while of the remaining 
86 more than one-half show lesions of tuberculosis on post- 
mortem examination, although dying from some other cause.. . 

The statement of von Behring above mentioned is particu- 
larly pertinent in regard to the relationship of human tuber- 
culosis to the milk supply, and especially in connection with the 
results of those investigators who have studied market milk 
and found from 5.2 to 55 per cent, of the samples examined 
to contain tubercle bacilli. LeBlanc considers the milk of 
tuberculous cows dangerous even when bacilli are not pres- 
ent, on account of the toxin it contains, Michellazzi has in- 
jected such milk into tuberculous animals and obtained a re- 
action. To eliminate all tuberciilous cattle from the herd, or 
to pasteurize ail milk coming from untested cattle, should 
therefore be the object of all producers of milk and the sani- 
tarians will be remiss in their whole duty should they neglect 
to guard against the products of tuberculous animals in their 
attempts to eradicate tuberculosis from man. 

Other Diseases. — Foot-and-mouth disease, anthrax, cow-pox, 
and rabies may be transmitted by the milk, and while no case 
of actinomycosis in man has been traced to the use of milk it 
is desirable that the use of milk of cows so affected should ue 
prohibited, especially when the disease affects the udder. Such 
conditions as gastroenteritis and septic and febrile conditions 
may render the milk injurious to the consumer. Local dis- 
eases of the udder like ]?otryomycosis, mammitis, mastitis, 
etc., nuiy render the milk unwholesome, especially when pus 
organisms are present. The color, taste and odor of milk may 
be altered so as to make it unpalatable if not unwholesome; 
these changes may be due to the food of the cow or to bacterial 
changes in the milk after it is drawn from the udder. Milk 
may acquire poisonous properties from the food eaten by the 
cow. The milk produced shortly before or during the first 
five days after parturition should not be used. 

Recommendations. — In view of the facts above enumerated, 
your committee desires to make the following recommenda- 
tions: 

1. All cows on dairy farms producing milk for the District 
of Columbia shall be tagged, tattooed or otherwise marked, for 
purpose of identification. 

2. All milk produced on such dairy farms shall come either 
from tuberculin tested cattle, which shall be retested at least 
once a year, or be subjected to pasteurization under the super- 
vision of tlie health departn;ent in case the herd is not tn])er- 
culin tested. 



10 

3. No additions to any herd, whether tested or not tested, 
shall be made in the future without subjecting such cattle to 
the tuberculin test. 

4. No license shall in future be granted except to applicants 
having herds free from tuberculosis. 

5. The milk of cattle showing any of the udder affections 
above mentioned, anthrax, rabies, gastroenteritis, septic condi- 
tions or clinical symptoms of tuberculosis, shall not be utilized 
as human food, even though the milk be pasteurized. Milk 
from cows 15 days before and 5 days after parturition, and 
that from animals receiving any of the deleterious medica- 
ments of foodstuffs previously mentioned shall likewise be ex- 
cluded. 

(). That the veterinary inspectors of the health department 
make frequent visits to dairies having untested herds, in order 
that they may discover all advanced cases of tuberculosis, or 
udder tuberculosis, as early as possible. 

MILK SEDIMENTS OR DIRTY ]\IILK IX RELATION 
TO DISEASE. 

BY GEORGE M. KOBER, M.D. 
Professor of Hygiene, School of Medicine, Georgetown Univt'-.-.-ity. 

Every consumer of milk has doubtless observed the presence 
of more or less foreign matter at the bottom of the bottle in 
which it is kept; indeed, it is a matter of such common occur- 
rence that it hardly excites our attention, and many are dis- 
posed to look on it as a matter of course. Professor Soxhlet 
of Munich was perhaps the first to point out that these depos- 
its are largely made up of the excrementitious matter from 
the cow, which adhering to the udder of the animal, gained 
access to the bucket during the act of milking. 

If these sediments are subjected to microscopical examina- 
tion we will find that they are composed of epithelial debris, 
hairs of the cow, organic and inorganic dust particles, excre- 
mentitious matter, vegetable fibers, bacteria, fungi and spores 
of every description; fully 90 per cent, of the germs are fecal 
bacilli — all of which is not only disgusting but extremely sug- 
gestive of danger. The number of micro-organisms is largely 
increased and we know that under a suitable temperature 
bacterial development and consequent decomposition are ma- 
terially hastened in such a medium. The greatest danger from 
milk of this class is the possible presence of ptomains or toxins 
produced by certain saprophytic germs from the albuminoids of 
the milk. 

The views of Vnughan. Booker, Escherich, Harrington. Kober 
and others on the relation of saprophytic germs and toxins to 
cholera infantum and the summer diarrheas in bottle-fed chil- 
dren are G'aininij jxroiind and will doubtless lead to great re- 
form in the management of dairie?;. It may be uro-ed that all 
sucli modern innovations involve unnecessary hardship, but it 



11 

should Ije remembered that by attacking all the various factors 
concerned in the causation of the disease we may hope for the 
best results. The reduction in the general mortality in the 
registration area of the United States from 19.G in 1890 to 
1G.2 per 1,000 shows what may be accomplished by preventive 
medicine and sanitation. 

MiJk in Relation to Infectious Diseases. — !Milk may acquire 
infective properties after it leaves the udder of the animal. 
Numerous instances have l)een observed in which outbreaks 
of typhoid fever, scarlet fever and diphtheria, by their sudden 
and explosive character, affecting families living in streets and 
localities supplied by the same milkman, naturally pointed to 
the milk supply as a common cause. Dr. Michael Taylor, how- 
ever, was the first physician (in 1857) to point out definitely 
that cow's milk might serve as the medium of spreading 
typhoid fever from a dairy where the disease prevailed. In 
1807 he also showed that scarlet fever might be distributed in 
the same way. In 1877 Mr. Jacob traced a diphtheria epi- 
demic at Sutton to the milk supply, and in 1872 ^[acXamarn 
traced an outbreak of cholera at Calcutta to an infected dairy. 
These facts* could not fail to sharpen the powers of observa- 
tion in others, so that in consequence similar outbreaks were 
more frequently reported. I was enabled to present to the 
International ]\redical Congress held in Paris in 1900 the 
history of 195 outbreaks of typhoid fever, ninety-nine of scarlet 
fever and six of diphtheria, all traceable to milk supply. 

It has been demonstrated that disease germs may not only 
survive, but in many instances actually proliferate, in the milk, 
and it is not a diflficult matter to point out the many ways by 
which these germs gain access, especially when some of the 
employes are also engaged in nursing the sick, or are sufiTering 
themselves from some mild infection wdiile continuing their 
duties, or are convalescent from the disease, and thus infect 
the milk in handling it. 

After the recital of numerous epidemics and milk-borne dis- 
eases. I need hardly insist on the necessity of compulsory no- 
tification of all infectious diseases, and that milk should not 
be permitted to leave a farm, dairy or milk-shop during the 
existence of any of these diseases among the inmates or em- 
ployes, nor should the latter be permitted to reside in or visit 
infected houses while engaged in the milk traffic Avithout per- 
mission from the health department. The farmer or retailer 
should, in fact, be prepared bv previous instructions to guard 
the milk supply from these sources of danger ana call on the 
authorities for an immediate inspection. To ])revent great 
loss incident to those restrictions, they may be modified so as 
to use the milk after proper sterilization under the direction 
of the health depirtinent. There is nothing strained in the 
requirements of the proposed legislation and by their enforce- 
ment we may hope to obtain such a standard of milk as will 



12 

not only effect a decided reduction in infantile mortality, but 
will render the dissemination of infectious diseases througa 
the milk supply a matter of history only. Until this is accom- 
plished, we should patronize only such dealers as sell "certified 
milk," or subject the milk to pasteurization, or simply bring 
the milk to the boiling point in the household, and, after cool- 
ing, keep it on ice; this will not make bad milk good, but it will 
at least destroy its infectiousness. 

SANITARY INSPECTION OF DAIRIES AND DIS- 
TRIBUTING DEPOTS. 

BY E. II. WEBSTER. 

Chief of Dah-y Division, Bureau of Animal Industry. 

A systematic sanitary inspection of dairy farms and milk- 
distributing depots are anything but ideal; they are, in fact, 
about as bad as it is possible to conceive. Stables are poorly 
lighted, many having no windows whatever, and ventilation 
is left to care for itself. Little attention is paid to floors, 
ceilings, walks, or stable j^ards. Swine, horses and poultry 
are often found in the same barn with the cows. Manure is 
not removed, or, when removed, is thrown through' an opening 
in the wall or just outside the door, frequently near the milk 
room. 

The necessary appliances for sterilizing and cooling in milk 
room are often lacking, making it impossible properly to wash 
and sterilize pails, cans, bottles and other appliances, or to 
properly cool and hold at a low temperature the milk before 
delivery. Milk dealers, as a rule, have more respect for san- 
itation and have better appliances than the average farm, but 
some common practices are deplorable. Very few have appli- 
ances for sterilizing bottles. 

The situation in Washington is not different from that con- 
fronting the health departments of most of the cities of any 
size throughout the country. The public is gradually awaken- 
ing to the fact that these conditions must be changed. In orner 
to bring about these changes within the district, it is recom- 
mended that: 

1. A sufficient number of inspectors shall be employed so 
that each inspector shall have not over 100 farm dairies. 

2. These men shall have technical training in the produc- 
tion and handling of milk. 

3. The health officers shall have full authority to make rules 
and regulations, and to enforce the same, so as to safeguard 
the milk supply of the district from contamination through 
carelessness, ignorance or malicious intent. 

4. The health officer, or any authorized inspector, shall have 
authority to revoke instantly the license or right to sell milk 
in the city if the provisions in these regulations are not com- 
plied with, where, in his judgment, such violation endangers 
the health of the consumer. 



13 
WATER SUrrLY OF DAIRY FAR:\rS. 

BY G. LLOYD MAGKUDER, M.D. 

Kmeritus Professor, Materia Medica and Therapeutics, Scliool of 
Medicine, Georgetown University. 

The inlliionce of a polluted Avater supply has long been rec- 
ognized as a most potent cause of disease. Many virulent epi- 
uemics have been directly traced to this origin. The literature 
on this subiect is so full of instances that it is needless to cite 
additional examples. Immediate closure of such water s)ip- 
plies in cities, when sewage bacteria have been detected, has 
been universally recommended. The recent report to the Dis- 
trict Commissioners by the bureau of Public Healtli and 
Marine-Hospital Service lays special stress on this point. 

How much more is this danger augmented when such bac- 
teria ore found in the water supply of the dairy farms. It is 
well known that few farms have the proper facilities for boil- 
ing tlie water tliat is used for washing the hands of the em- 
ployes, the dairy utensils and the udders of cows. Such water 
readily contaminates the milk, which contamination is rap- 
idly increased by the multiplication of the bacteria wlien the 
temperature is above 50 F. 

In view of the possible presence of the bacilli of typhoid 
fever and tuberculosis, the question of sewage bacteria in the 
water supplies of the dairy farms is a nuich more serious 
matter tlian was formerly considered. The knowledge thnt 
typhoid fever was 2% times more prevalent in 190G in the 
counties of Maryland than in the city of Baltimore, and the 
evidence, as stated elsewhere in this report that 148 out of 
19o epidemics of typhoid fever attributed to milk were directly 
traced to the dairy farm, adds to the seriousness of these con- 
ditions. 

It has been observed that many wells, springs and cisterns 
are loosely or not at all covered, poorly protected from surface 
drainage, and, in numerous eases, are located in close prox- 
imity to the barnyard or to the household privy, at times even 
in places that catch the drainage from tlie same. 

The examinations made by officials of the Department of 
Agriculture during November and December, 1900, in com- 
])aratively cool weather, showed that, of the CO water supplies 
of dairj^ farms taken at random in Maryland, Virginia and 
the District of Columbia, 10 contained less than 500 bacteria 
per cubic centimeter and were free from Bacillus colt — G below 
this number contained the colon bacillus. The remaining 44 
water suplies contained bacteria up to 27.200. Of these 44, 21 
contained the colon bacillus. 

These tests warranted the classification of these water sup- 
plies as follows: 10 good, 15 fair, 17 suspicious, and 12 unfit 
for use. From Professor Sedgwick's classification 44 would 
Imve [)een considered polluted. In a recent letter he snys: ''I 



14 

should say that all of the wells under consideration which 
had more than 100 bacteria per cubic centimeter were to be 
classed as suspicious, and that those having 500 or over were, 
in all probability, polluted." 

The results of those examinations confirm the wisdom of the 
recommendation made in 1894 by the committee of the Med- 
ical Society of the District of Columbia on the prevalence 
of typhoid fever, for the careful inspection of all dairy farms 
for all possible sources of infection, including the water supply, 
and prove that repeated chemical and bacterial tests should 
be made of the water supplies of every dairy farm supplying 
milk to the City of Washington. They afford another proof 
of the imperative need of a well-equipped chemical and bac- 
teriological laboratory for the Health Officer. 

Fortunately, many of these insanitary conditions on the 
farm can be readily and easily remedied by the farmer himself, 
by the exercise of a little care and at a very trifling cost. 

All water, except that above suspicion, used for dairy pur- 
poses should be boiled. Those engaged in the handling of 
dairy products should be required to observe the greatest care 
as to the cleanliness of their clothes and person. Frequent 
washing of their hands should be practiced. The source of the 
water supply should be at least fifty feet from any possible 
infection, and a greater distance if in line of drainage from 
any infection. 

The wells, springs and cisterns should be carefully walled 
and covered to protect them from seepage, drippings and dust. 
A well-built coping, extending a foot or more above the ground 
would be very effectual. Preferably deep driven wells should 
be used when possible. Owing to the inclination of the rock 
formation in this vicinity, these are not always absolutely re- 
liable. When a water supply is found to be polluted, it should 
be thoroughly cleaned and properly disinfected. 

All fecal discharges should be deposited in a safe place, and 
those from fever cases in addition should be intelligently disin- 
fected. Since freezing does not immediately kill bacteria, care- 
ful supervision shouid also be observed over the supply of 
water for and the location of ice ponds from which ice is 
obtained for household and dairy purposes. By observing those 
simple precautions, which Avould in no way be a hardship to 
the producers, much would be accomplished toward securing a 
better milk suppply. 

The series of check experiments conducted during September, 
October and November, 1900, by the Department of Agricul- 
ture and those in charge of the filtration plant, demonstrated 
its efficiency as a safeguard against typhoid infection from the 
Potomac River. The report of the examinations of the Poto- 
mac Water Supply for March confirms the deduction hereto- 
fore made. 



15 

COMMKKCIAI. CLASSES OF MILK. 

IJY A. I). MELVIX. M.D. 
Chief of the Bureau of Animal Industry. 

In view of the elaborate manner in which the necessity for 
a pure milk supply has been pointed out, and of the many 
obstacles in the way of obtaining such a supply except through 
vigorous official supervision, it is believed that if the milk sup- 
ply is divided into three classes as hereinafter described, and 
an efficient supervision provided, the consumer will be amply 
protected in securing clean and uncontaminated milk, therefore 
the following recommendations are respectfully submitted: 

That the milk supply of the city be divided into three classes, 
to be known as Classes 1, 2 and 3. The specifications for certi- 
fied milk for infants to be the same as recommended by the 
^lilk Commission, and to be known as Class I. 

Class 2 to be clean, raw milk from healthy cows as deter- 
mined by the tuberculin test and veterinary physical exam- 
ination. The cows to be housed, fed and milked under good 
conditions, but not necessarily equal to the conditions pro- 
vided for Class I. Pure water as determined by chemical and 
bacteriologic examination, to be provided and the bacteriologic 
count of tlie milk not to exceed 100.000 bacteria per c.c, at 
the time the milk reaches the city, at any season of the year, 
and determined by the health department at frequent inter- 
vals. ;Milk to be delivered to the consumer in sterilized con- 
tainers to be filled on the dairy farm and the temperature of 
the milk not to exceed 50 F. until delivered to the consumer. 

Class 3 to be milk from all other dairies not able to comply 
with the requirements for Classes 1 and 2. This milk to be 
clarified and pasteurized at central pasteurizing plants which 
shall be under the personal supervision of an officer of the 
health department. These pasteurizing plants may be pro- 
vided by either private enterprise or by District government, 
and shall be located within the city of Washington. Class 3 
milk shall not be permitted to exceed GO F. in delivery from 
the dairy to the pasteurizing plants. The milk from these 
pasteurizing plants, placed in sterilized containers, shall be 
delivered to the consumer at a temperature not exceeding 
50 F. All milk of unknown origin shall be placed under Class 
3 and subjected to clarification and pasteurization. It is also 
provided that no cows suO'ering from any communicable din- 
ease, or any unfit condition to be determined on physical 
examination by an authorized veterinarian, shall be permitted 
in any dairies. It is further provided that cow^s which do not 
show any physical signs of tuberculosis on veterinary exam- 
ination, but wdiich may have reacted to the tuberculin test, 
may be included in dairies supplying milk of this class. 

No dairy farm shall be permitted to supply milk of a higher 
class than the class for which the permit has been issued and 
each dairy farm supplying milk of a specified class shall be 



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separate and distinct from any dairy farm of a different class; 
the same owner, however, may supply different classes of milk, 
providing the dairy farms are separate and distinct, as above 
indicated. All milk to be of good composition, free of adul- 
terants and artificial coloring matter. The term "milk"' to 
include both milk and cream. 

PASTEURIZATION. 

BY M. J. P.OSENAU, M.D. 
Director Hygiene Laboratory, U. S. P. H. and M.-H. S. 
Advantages. — The advantage of pasteurization is that it is 
a cheap and effective means of preventing the transmission of 
infectious diseases such as tuberculosis, typhoid fever, diph- 
theria, scarlet fever, etc., commonly spread by milk. 

Disadvantages. — 1. Pasteurization promotes carelessness on 
the farm and dairy, etc. (This may be controlled by proper 
regulations, inspections and laboratory examinations.) 

2. Pasteurization rentiers milk less digestible. (While it is 
generally conceded that boiled milk commonly induces con- 
stipation, the majority of the evidence plainly indicates tliat 
pasteurization has little, if any, effect on the digestibility of 
the milk.) 

3. Pasteurized milk favors the production of rickets and 
scurvy. (There is no proof to this effect and authorities agree 
that the danger is slight; and, further, that it may readily 
be obviated.) 

4. By destroying the non-spore-bearing bacteria, pasteuriza- 
tion sometimes allows toxic organisms to grow and produce 
serious poisons in the milk. (On the other hand, these same 
poisons are more frequently produced in milk that has not 
been pasteurized, and this danger may be obviated in pas- 
teurized milk by cooling it quickly, keeping it cold and short- 
ening the time for distribution. ) 

5. Pasteurization is inefficient as a preservative; the milk 
keeps only 12 to 24 hours longer than otherwise. (This is really 
no disadvantage, for the quicker bad milk sours, the better.) 

6. Pasteurization injures the taste of the milk. (This is jiot 
so, if properly done.) 

7. Pasteurization increases the cost of the milk. (True, 1r.it 
it is the cheapest safeguard, and the expense of pasteuriza- 
tion is offset by the keeping quality of the milk. ) 

Methods. — The milk must be heated to a temperature of 
65 C. (149 F.) for 20 minutes, or 70 C. (158 F.) for 10 min- 
utes, as soon as practicable after the milking, in enclosed ves- 
sels, preferably the final containers. After pasteurization, the 
milk must be promptly cooled, kept cold and distributed with 
promptness. 

The advantages so far outweigh the disadvantages that I un- 
liesitatingly recommend compulsory pasteurization of all milk 
not certified under Class 1 and Class 2 of Dr. Melvin's classi- 
fV-r.tio;i. 



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Hollinger Corp. 
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